A health-care heart attack and the doctor says diet!

Arthur Caplan

February 11, 1993|By Arthur Caplan

THE Health Care Financing Administration, the folks in the federal government who run the Medicare program, just issued a report stating that our collective bill for health care will hit $1.7 trillion by the year 2000.

In less than seven years medical costs will be eating up more than 18 percent of the nation's entire economic output. Current rates of spending on medical care in the United States are absolutely bonkers. Health care costs are ruining our economic competitiveness, skewing our domestic spending, destroying jobs and ruining our children's future by saddling them with backbreaking levels of debt.

Some folks in Washington don't seem to understand we are facing a national emergency. When the HCFA economists told their boss, Donna Shalala, recently installed as the secretary of health and human services, that the nation faced the prospect of a complete economic collapse as a result of the bills being submitted by its doctors, hospitals and nursing homes, she responded with a rhetorical yawn.

The best she could do in the face of the news that the country is right on course to strike a $2 trillion fiscal iceberg was to squeak that "we need a health care system that delivers quality care for all our people at reasonable cost."

Health care spending is giving us a heart attack but the chief doctor is telling us to go on a diet.

The only hope for administering the drastic therapy the nation requires is Hillary Rodham Clinton. When, after much solemn discussion, the president's transition team presented him at the beginning of January with a health reform plan that would add $40 billion to present spending levels while promising some leveling off of expenditures in three to five years, he promptly and appropriately tossed it in the circular file.

The president turned to a person he knew to be tough enough to take on the special interests who want to get their hands on that $1.7 trillion ` his wife.

Hillary Clinton is as familiar as anyone in the new administration with the crisis that passes for health care in the United States. She has worked unstintingly on behalf of better health for children through such exemplary organizations as the Children's Defense Fund.

She knows there is no way to square the need to improve access to health care for the uninsured and with the necessity to contain costs without asking a lot of people to make sacrifices.

The current approach to matters of cost and access is to let those who can pay get more, while those who cannot get what charity will allow. This Scroogean algorithm strikes more and more people as grossly unfair.

The alternatives are to more equitably redistribute the money now being spent, wring more efficiency out of current expenditures, cut benefits or spend more.

The first two have far more to recommend them in terms of equity than the latter do.

What Hillary Clinton must do is get the nation to accept the idea that ceilings are going to have to be placed on health care expenditures, especially if floors are going to be built for those now without access to health care.

She must also persuade Americans that they may have to give up access to the marginal and fringe elements of health care so that others will have access to the basic and the standard components.

Finally, she must convince providers and insurers that the party is over in terms of high profits in health care and that the government will be playing an aggressive role in managing prices, mandating access and controlling insurance rates.

When a health care system is as sick as ours, there is no time for delay in administering treatment. Let's hope that Hillary Clinton recognizes that the time for the same old song is long since past and that she is prepared to get us all on a new page singing loudly in a very different key.